Your Body Is Sending You a Message
By Dr. Dean Fishman
Neck Pain Caused by Texting
| Fast Facts: The Consequences of Forward Head Posture 1. Long-term forward neck posture leads to "long-term muscle strain, disc herniations and pinched nerves." (Mayo Clinic Health Letter, March 2000) 2. In regard to respiratory dysfunction in chronic neck pain patients, a recent study "demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck patients." (Cephalgia, February 2009) 3. "For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds." (Kapandji, Physiology of the Joints, Volume 3) 4. "Loss of the cervical curve stretches the spinal cord 5-7 cm and causes disease." (Dr. Alf Breig, neurosurgeon and Nobel Prize recipient) 5. "90% of the stimulation and nutrition to the brain is generated by the movement of the spine," says Dr. Roger Sperry, Nobel Prize recipient for brain research. Dr. Sperry demonstrated that 90 percent of the energy output of the brain is used in relating the physical body to gravity. Only 10 percent has to do with thinking, metabolism, and healing, so when you have forward head posture, your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing. 6. According to Rene Cailliet MD, director of the Department of Physical Medicine and Rehabilitation at the University of Southern California, forward head posture can add up to 30 pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. FHP results in loss of vital capacity of the lungs by as much as 30 percent. This shortness of breath can lead to heart and blood vascular disease. The entire gastrointestinal system is affected; particularly the large intestine. Loss of good bowel peristaltic function and evacuation is a common effect of FHP. It causes an increase in discomfort and pain because proprioceptive signals from the first four cervical vertebrae are a major source of the stimuli which create the body's pain controlling chemicals (endorphins). With inadequate endorphin production, many otherwise non-painful sensations are experienced as pain. FHP dramatically reduces endorphin production. 7. FHP has been shown to flatten the normal neck curve, resulting in disc compression, damage and early arthritis. Spine, 1986) |
Technology Overload
These days, people are constantly "connected" to their hand-held devices, whether it is their cellular phones, portable video games like Nintendo DS, e-readers such as Amazon Kindle, or they are just using apps on an iPhone. A Kaiser Family Foundation survey found that young people 8-18 years old spend in excess of seven-and-a-half hours a day using some form of mobile media. As a result, this younger demographic will surely be developing a condition known as forward head posture (FHP), which can cause the above symptoms and more.
As technology advances in the market of hand-held mobile devices, it's important to understand that where the head goes, the body will follow. If you have forward head posture, then you will have rolled shoulders. With rolled shoulders, a concave chest can follow, and often a pelvic tuck, all of which can contribute to progressive pain and dysfunction over time.
Text messaging was reported to have addictive tendencies in the Global Messaging Survey by Nokia in 2001, and was confirmed to be addictive in a study conducted at the Catholic University of Leuven in Belgium in 2004. Since then, a study at the University of Queensland in Australia has found that text messaging is the most addictive digital service. It has been compared to being as addictive as cigarette smoking. The text reception habit introduces a need to remain connected, called "reachability."
Because the demographic of people ages 13-27 is one of the largest groups of texters, we can expect to see a large increase of medical and chiropractic conditions within the next decade. The amount of time spent in a forward head tilt while texting or gaming, surfing or browsing the Web has increased as hand-held mobile devices such as cell phones, video games, and MP3 players have become smaller, mobile and essentially a direct extension of the person. Look around you and you will see people with FHP using hand-held mobile device at tables in restaurants, at red lights in their cars, walking through the mall, in line at the grocery store, and even sitting in doctors' reception areas. We are a society that is "connected," now more than ever before, and we are suffering the health consequences.
The problem is getting worse each year. According to data released Dec. 15, 2009, by the Census Bureau, Americans sent 110 billion text messages in December 2008. In the same month in 2007, Americans sent 48 billion messages. Amanda Lenhart, a senior research specialist for the Pew Internet and American Life Project, is not surprised that the trend is especially prevalent among teenagers. In a Los Angeles Times article (Dec. 16, 2009), she stated: "Teens are still developing their communication habits. Adults have preset ones already."
The world is becoming more mobile. Children are getting mobile phones at younger and younger ages due to affordable prices and parents wanting to stay in touch. Hand-held mobile devices are performing more daily functions and are more portable than ever. Google's vice president of engineering and mobile applications, Vic Gundotra, has noted: "We are seeing a very fundamental shift where increasingly, particularly among the young demographic and in Asian countries, the primary access to the Internet is not through the PC but through mobile devices."
The Problem's Not Going Away
Research performed by Informa Telecoms & Media reported that in 2008, almost 162 million smartphones were sold, surpassing laptop sales for the first time. The research also suggests that smartphone sales will continue to be immune to the global economic downturn. With technology advancing, sales of the hand-held mobile device staying strong and people's desire to stay connected, FHP will be more prevalent than ever.
Of course, forward head posture is not a new condition. Chiropractors have been treating and educating patients on the dangers of FHP for years, and the health conditions that FHP or anterior head carriage contribute to are well-researched and documented. [See "Fast Facts" table on the previous page.]
With all this said, it's important to understand the negative effects of a repetitive stress syndrome and appreciate how many hours you are using your hand-held mobile devices and how many hours your children are using these devices. Talk to your doctor about forward head posture, the dangers of text messaging and other behaviors that put your body in stressful positions, and how you can avoid the pain before it starts.
When Texting Turns Deadly
Can't stop texting? If forward head posture doesn't concern you (even though it should), the Federal Motor Carrier Safety Administration has found that of 17 activities that can drawn a driver's attention from the road, texting puts you at greatest risk for suffering a serious car crash. According to the National Safety Council, an estimated 28 percent of crashes (1.6 million annually) are attributable to talking and/or texting on cell phones while driving.
According to Dr. John Callaghan, president of the American Academy of Orthopedic Surgeons, "The problem with the use of 24/7 communications devices is that every driver believes he or she is immune to slip ups, but isn't. Orthopaedic surgeons want to prevent the pain and suffering associated with texting-and-driving accidents. To say this habit can be deadly is the truth; it is an outcome we unfortunately see every day."
Heal your Mind, Heal your Body
Health is one of the most important aspects of our life, when we have it, we often take it for granted and get busy enjoying all the other things in life. However, when we do not, it can hang over our lives like a dark cloud.
Let me tell you something startling and I believe it to be true with all my heart. In many cases disease of the body is a result of dis-ease in the mind, soul, spirit, subconscious, call it what you will. The good news is, that means we can do something about it.
disease of the body results from dis-ease in the mind
Eastern societies have long recognised this link and their medicinal techniques reflect a much more "holistic" approach to healing. It is a reality that our thoughts are closely linked to our physical bodies, dysfunction in one is often reflected in the other. Western medicine tends to treat symptoms, often successfully "making it go away", but fail to treat the cause, raising the possibility of recurrence in one form or another.
Back Surgery: Too Many, Too Costly, Too ineffective, Part 4
By J.C. Smith, MA, DC
Treatment of Choice
The truth is now emerging. There is now broad agreement internationally that surgery should not generally be considered until there has been a trial of conservative nonsurgical care. Pran Manga conducted two studies in the 1990s and noted, "There should be a shift in policy now to encourage the utilization of chiropractic services for the management of low back pain, given the impressive body of evidence on the effectiveness and comparative cost-effectiveness of these services, and on the high levels of patient satisfaction."86 As well, an editorial in the Annals of Internal Medicine published jointly by the American College of Physicians and the American Society of Internal Medicine (1998) noted that "spinal manipulation is the treatment of choice":
"The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain87 ... Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice."88 (Emphasis added)
More spine experts are emerging from the medical closet to express their support for chiropractors, although most remain cautious with the fear of reprisal from their surgical peers who profit greatly from spine surgery.
William Lauerman, MD, chief of spine surgery, professor of orthopedic surgery at Georgetown University Hospital, has stated: "I'm an orthopedic spine surgeon, so I treat all sorts of back problems, and I'm a big believer in chiropractic."89
Richard Deyo, MD, MPH, has mentioned chiropractic as a solution: "Chiropractic is the most common choice, and evidence accumulates that spinal manipulation may indeed be an effective short-term pain remedy for patients with recent back problems."90
Gordon Waddell, MD, also has suggested chiropractic care as a solution: "There is now considerable evidence that manipulation can be an effective method of providing symptomatic relief for some patients with acute low back pain."91
Jo Jordan, PhD, wrote that spinal manipulation may be the "lone ray of light" for back pain treatment.92
The Back Letter editorial staff also noticed the stubbornness of physicians to implement the new guidelines for low back pain, which includes the use of spinal manipulation as a first route of treatment before surgery.93
Although most MDs and many in the public remain convinced that a disc problem requires surgery, most guidelines now recommend nonsurgical care before surgery. The North American Spine Society (NASS), the same organization that attacked the AHCPR findings in 1994, has now published online a Public Education Series that includes "Spinal Fusion." Remarkably, this explanation proved to be very accurate, including the opinion that "[f]usion under these conditions is usually viewed as a last resort and should be considered only after other conservative (nonsurgical) measures have failed."94
The admission by NASS that fusion should be a last resort is a huge warning that has been unheard by the public. More surprisingly, NASS again admitted that spinal manipulation should be considered before surgery in the October 2010 edition of The Spine Journal:
"Several RCTs (random controlled trials) have been conducted to assess the efficacy of SMT (spinal manipulative therapy) for acute LBP (low back pain) using various methods. Results from most studies suggest that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up. Spine care clinicians should discuss the role of SMT as a treatment option for patients with acute LBP who do not find adequate symptomatic relief with self-care and education alone."95 (Emphasis added)
Indeed, it is past time for every physician to follow this advice and stop prescribing pain pills, muscle relaxers, epidural steroid injections and MRI scans that lead to unnecessary spine surgeries. It is time for all primary care MDs to refer patients to chiropractors for their hands-on care before any drugs, shots or surgery is suggested. It is past time for physicians to follow the Hippocratic Oath to do no harm, and the current medical practice for back pain is doing great harm to many patients.
Dr. Rick McMichael, president of the American Chiropractic Association, recently spoke on this important issue with regard to reducing costs for health care:
"America cannot expect to significantly change its health care outcomes and the costs of health care unless we are willing to make some significant changes in how we deliver health care services. We must reduce the excessive use of pain meds and unnecessary surgeries. Positioning doctors of chiropractic as first-contact, portal-of-entry, primary care providers for a larger segment of the nation's patient population holds great promise as one very important change that could significantly impact health care outcomes and reduce health care costs.
"We must press forward for full implementation of Section 2706 of the Patient Protection and Affordable Care Act to stop the discrimination against DCs and other licensed health care providers. Full implementation of this new law will change our health care system dramatically, offer patients a real choice of health care and provider type, improve patient outcomes and satisfaction levels, and reduce overall health care costs. This change is long past due!"96
Resolving Back Pain Without Surgery: Get the Message Out
Chiropractors, once the forbidden fruit of the medical world, today have become the fiscal darlings in the medical world who can reduce the huge expense as well as save thousands of patients from unnecessary spine surgery. Of course, the medical profession has no interest in seeing this evidence-based approach cut into its billion-dollar spine surgery business, especially by chiropractors.
The AHCPR battle with NASS on Capitol Hill was evidence of the medical resistance to evidence-based research. Indeed, American medicine is renowned for its intransigence considering it takes 17 years for a new method to be incorporated into the mainstream while it takes 44 years for an ineffective method to be removed.97
Indeed, this begs the question: Will it take 44 years before the tsunami of back surgeries ends and people finally learn that chiropractic care is the preferred choice of treatment for the majority of back pain cases?
It is our duty to bring this message to the public. The facts are clear that drugs, shots and spine surgery have not stopped the rising tide in the tsunami of back pain, and reliance upon these treatments may actually be worsening the problem; indeed, medical spine care today is a shot in the dark with suspect treatments, unreliable outcomes and at great expense.
On the other hand, there are ethical orthopedists who are well-aware of the misfortune of back surgery. Jens Ivar Brox, MD, lead investigator of the Norway Spine Study, reported that he and his colleagues "no longer perform spinal fusion specifically for 'degenerative disc disease' because they do not regard it as a clearly diagnosable entity."98
Dr. Brox admitted some of the orthopaedic surgeons in his department have recurrent back pain and disc degeneration, but these surgeons refuse to have fusion surgery or recommend fusion surgery for their family members. "So the question is: Why should we recommend these procedures for our patients?" Finally, an honest surgeon speaks.
Every American spine surgeon should ask themselves the same question: will they be so quick to do surgery on their own family members (or have it done on oneself) as they do on their patients?
If this evidence-based health care reform movement seriously wants to lower costs and improve outcomes in the epidemic of back pain, the chiropractic profession stands as fiscal and health care conservatives to help solve this huge issue. Of course, this back pain issue has not discussed other ways chiropractors can help, such as with wellness care, neurogenic illnesses, pediatric, geriatric, sport injuries or the many issues that fall under our scope of practice - all important issues the public needs to learn.
Until the day finally arrives that chiropractic care escapes the fog of skepticism, "buyer beware" is the best advice for patients until they understand that chiropractic, as Dr. Rosner mentioned, "at least for back pain, appears to have vaulted from last to first place as a treatment option."99
Chiropractic vs. Medicine for Acute LBP: No Contest
Acute low back pain patients demonstrate significantly greater improvement with chiropractic than "usual care."
By Editorial Staff
With the publication of the Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study1 in The Spine Journal, one of the most frequently cited spine research journals in the world,2 the health care community at large may finally appreciate what the chiropractic profession has known for more than a century: Patients with acute mechanical low back pain enjoy significant improvement with chiropractic care, but little to no improvement with the usual care they receive from a family physician. Published in the December 2010 edition of The Spine Journal, the study found that after 16 weeks of care, patients referred to medical doctors saw almost no improvement in their disability scores, were likely to still be taking pain drugs and saw no benefit with added physical therapy - and yet were unlikely to be referred to a doctor of chiropractic. The study is "the first reported randomized controlled trial comparing full CPG [clinical practice guidelines]-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC [usual care] in the treatment of patients with AM-LBP (acute mechanical low back pain)." (Evidence-based clinical practice guidelines have been established for acute mechanical low back pain in many countries around the world, but sadly, most primary care medical doctors don't follow these guidelines.) Researchers found that "treatment including CSMT [chiropractic spinal manipulative therapy] is associated with significantly greater improvement in condition-specific functioning" than usual care provided by a family physician.
Study Parameters
The Chiropractic Hospital-based Interventions Research Outcome (CHIRO) initiative was "designed to evaluate the outcomes of spinal pain patient management strategies that involve a component of chiropractic assessment and/or spinal manipulative therapy, administered in a hospital-based spine program outpatient clinic." The study utilized the CHIRO framework "to examine the effectiveness of current evidence-based CPG-recommended treatments for patients with AM-LBP pain."
CPG "study care" (SC) was compared with the usual care (UC) provided by family physicians. Patients were first seen by a spine physician and then randomly assigned to either the SC group or the UC group.
Patients in the SC group received acetaminophen, a "progressive walking program" and up to four weeks of lumbar chiropractic spinal manipulative therapy. The manipulative therapy was provided "using conventional side-posture, high-velocity, low-amplitude techniques" to the lumbar region only, and only by a chiropractor.
Patients assigned to the UC group were referred back to their family physician, who was "simply advised to treat at their own discretion." Patients in this group received treatment from "a variety of professionals including family physicians, massage therapists, kinesiologists, and/or physiotherapists."
All care was provided at a hospital-based spine program outpatient clinic. The primary outcome measure was the Roland-Morris Disability Questionnaire (RDQ), administered at the beginning of care and at 16 weeks, when acute low back pain is considered to become chronic. The RDQ was also administered at eight and 24 weeks.
Other Important Findings
After 16 weeks, "78% of patients in the UC group were still taking narcotic analgesic medications on either a daily or as needed basis." (Only 6 percent of this group received chiropractic care.)
Condition-specific improvement after 16 weeks "clearly favored the SC group, with mean RDQ improvement scores of 2.7 in the SC group compared with only 0.1 in the UC group (p=.003)."
While the difference in improvement "was not quite significant at 8 weeks," it was found to be "clearly significant at 24 weeks of follow-up (0.004)."
Both groups showed improvement in bodily pain and physical functioning, but "patients in the UC group uniquely showed no improvement whatsoever in back-specific functioning (RDQ scores) throughout the entire study period."
The inclusion of NSAIDs and manipulation/mobilization performed by physical therapists were no more effective in treating patients than family doctors who offered patients advice and acetaminophen. The study found: "[T]he addition of NSAIDs and a form of spinal manipulative therapy or mobilization administered by a physiotherapist to the lumbar spine, thoracic spine, sacroiliac joint, pelvis, and hip (compared with a detuned ultrasound as placebo manipulative therapy), to family physician 'advice' and acetaminophen were shown to have no clinically worthwhile benefit when compared with advice and acetaminophen alone." [Italics ours] The study criticizes a 2007 report that had derided the efficacy of spinal manipulation by pointing out that the older report based its conclusions on the outcomes of therapies performed by non-chiropractors. The 2007 study concluded that patients "do not recover more quickly with the addition of diclofenac or spinal manipulative therapy."3 By contrast, the CHIRO study noted: "Although spinal-manipulative therapy is currently administered by many different healthcare professionals, including: chiropractors, osteopaths, orthopedic surgeons, family physicians, kinesiologists, naturopaths, and physiotherapists, the levels of training and clinical acumen vary widely. The study design used by Hancock, et al., therefore, differs from our study because [their study] did not use chiropracticspinal manipulation, and current guideline based care does not endorse any forms of spinal manipulation administered by any other practitioners." [Italics ours]
References
- Bishop PB, Quon JA, Fisher CG, Dvorak MFS. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine Journal, 2010;10:1055-1064. www.ncbi.nlm.nih.gov/pubmed/20889389
- Brunarski D. "Impact of the Chiropractic Literature." Dynamic Chiropractic, Dec. 2, 2010;28(25).
- Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, Spindler MF, McAuley JH. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet, 2007 Nov 10;370(9599):1638-43. www.ncbi.nlm.nih.gov/pubmed/17993364
